2026 EMERGE Serves Application

Are you currently an active EMERGE member?

Name

First NameLast Name

Name (preference)

Present Employer

Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

Work Phone

Area CodePhone Number

Mobile Phone

Area CodePhone Number

Email

example@example.com

Position Held

How Long Have You Worked for Your Employer?

COMMUNITY/ORGANIZATION/ACTIVITY INFORMATION

Please list the Organization Name, Position Held and the dates in the box below. List community/business/professional organizations and activities in which you have participated. (Including academic, not limited to Lakeland):

Why are you most interested in participating in EMERGE Serves?

AREAS OF INTEREST

Anything else you would like to share?

I understand that the EMERGE Serves program will be held each of the following Tuesdays:

- August 18, 2026 @ Lakeland Chamber // 4:30-7:00 pm
- August 25, 2026 @ Lakeland Chamber // 4:30-7:00 pm
- September 1, 2026 @ Lakeland Chamber // 4:30-7:00 pm
- September 8, 2026 @ Lakeland Chamber // 4:30-7:00 pm
- September 15, 2026 @ Lakeland Chamber // 4:30-7:00 pm
- September 22, 2026 @ First Presbyterian Church - Graduation // 5:30-7:30 pm.

Lakeland Chamber of Commerce - 35 Lake Morton Dr., Lakeland, FL 33801
First Presbyterian Church - 175 Lake Hollingsworth Dr., Lakeland, FL 33801

Attendance at all sessions is mandatory to graduate from the program. The community leaders have been gracious enough to carve out their time to be with each of you, so it is important that you be here each night. By signing below, you indicate that you can devote this time to the program. I authorize the Lakeland Chamber of Commerce or the United Way of Central Florida may share my information with agencies and organizations exclusively for board or volunteer service opportunities tthat match my community service areas of interest.

Applicant's Signature and Date:

All Applications must be received by August 1, 2026, to be considered. Participation is limited to current EMERGE members. Class size is extremely limited.